This document discusses the link between poorly controlled diabetes and eating disorders. Around 40% of people with type 1 diabetes report abusing insulin to manage their weight, which can have serious health consequences. However, eating disorder services have no insulin-dependent diabetics on their books despite estimates that at least 26 of the around 170 people at risk would have an eating disorder. The document argues more needs to be done to identify and support people with both diabetes and an eating disorder, including asking sensitive questions and taking a team-based treatment approach given the complex risks of this dual diagnosis.

1. Poorly controlled diabetes and
Eating Disorders
Micki Bennett
Community Eating Disorder Services
Manager

2. Why this talk?
• 40% of Type 1 admit to abusing insulin to manage
their weight.
• Consequences of doing so are serious and
permanent
• Highest incidence of death in Type 1 diabetes is in
the age group 16-25
• Highest incidence of eating disorder onset is
under 25 – Coincidence?
• 41% people with diabetes estimated to have poor
psychological wellbeing

3. What about Type 2
• Type 2 is increasing in prevalence
• Happening at a younger age
• Increasingly using Insulin as treatment.
• Weight management is prioritised in Type 2

4. Consequences
• Addiction – this is how sufferers describe it.
• Ketoacidosis
• Blindness
• Amputations
• Death

5. Numbers
• Type 1 Diabetes 24.5 per 100,000
• Type 2 Diabetes 400 per 100,000
• At least 40% = 169.8 people potentially at risk
because the behaviour is reported to be addictive
• Eating disorder prevalence is thought to be
around 6.5% of population. It is higher in those
with diabetes
• Of those 169.8 at least 26 will have an eating
disorder

6. BUT
• The county wide eating disorder service
currently has no insulin dependent diabetics
on its books.
• Where are these people?
• Where is their support?
• Why are they not being referred?

7. • Every insulin dependent diabetes sufferer is in
contact with a health professional.
• Every insulin dependent diabetes sufferer has
blood tests. HbA1c.
• Blood tests show treatment compliance long
term.
• Any evidence of high blood sugars from these
tests are treated with an increase in
prescribed insulin. So that’s alright then?

8. BUT
• What if you are not asked whether you take
your insulin regularly?
• What if you are not honest about it because
you have an eating disorder (a serious mental
illness)?
• What if you never see a professional with
experience of eating disorders?
• Why would you not ask for help?
• It’s not just insulin abuse.

9. Fear
• Abusing insulin is easy – just this once!
• Managing diabetes is hard anyway.
• Weight management is valued socially.
• Weight management is encouraged in
diabetes.
• Admitting you abuse insulin is a bad thing.
• Admitting you would rather be thin.

10. But what if you do admit it?
• Who knows how to treat this?
• I have no experience of diabetes.
• I know what works in eating disorders.
• We need a team approach.
• We need sensitivity to the risk of this dual
diagnosis.
• We need the courage to ask difficult questions.
• We need to know what to do with the answers.